A guide to strategic planning.

Strategic planning is a new concept in general practice. Underneath all the jargon, however, it is simply a label for the planning and evaluation processes that most organisations have used in the past. The aim of this paper is to demystify strategic planning as it applies to newly formed Divisions of General Practice.

Phytate and zinc bioavailability.

This review discusses evidence from human studies on the effects of dietary phytate on zinc bioavailability. In vitro and animal experiments have implicated calcium as a potentiating factor because it reacts with phytate, and zinc binds to the precipitate. Magnesium also reacts similarly to calcium, but most studies have not considered this factor.

Two different Escherichia coli proP promoters respond to osmotic and growth phase signals.

proP of Escherichia coli encodes an active transport system for proline and glycine betaine which is activated by both hyperosmolarity and amino acid-limited growth. proP DNA sequences far upstream from the translational start site are strongly homologous to the promoter of proU, an operon that specifies another osmoregulated glycine betaine transport system. Mutation and deletion analysis of proP and primer extension experiments established that this promoter, P1, was responsible for proP's strong expression in minimal medium and its response to osmotic signals.

Four additional genes in the sigB operon of Bacillus subtilis that control activity of the general stress factor sigma B in response to environmental signals.

sigma B of the gram-positive bacterium Bacillus subtilis is an alternative transcription factor activated by a variety of environmental stresses, including the stress imposed upon entry into the stationary growth phase. Previous reports have shown that this stationary-phase activation is enhanced when cells are grown in rich medium containing glucose and glutamine. The sigma B structural gene, sigB, lies in an operon with three other genes whose products have been shown to control sigma B activity in response to environmental stress.

Isolation of a putative receptor from Zea mays microsomal membranes that interacts with the G-protein, GP alpha 1.

The C-terminal region of a heterotrimeric G-protein alpha-subunit is known to be one of the principal determinants governing its interaction with its cognate receptor. Use of an oligopeptide corresponding to the fifteen C-terminal residues of the Arabidopsis G alpha-subunit (GP alpha 1), as an affinity ligand, led to the resolution of a tightly binding 37 kDa membrane polypeptide from detergent solubilised Zea microsomal fraction membranes. An identical polypeptide bound tightly to an affinity matrix containing recombinant GP alpha 1 protein as ligand: binding and release of this 37 kDa protein was dependent on the activation state of GP alpha 1 which was regulated by inclusion or omission of the G-protein activator AlF-4.

Training for rural general practice.

Objective: To identify requirements for vocational training and continuing education programs in rural general practice.

Design: A questionnaire was sent to all 487 rural doctors and 140 metropolitan and 140 provincial city general practitioners (GPs) in Queensland. A sample of medical educators, health professional and consumer representatives and rural doctors was also interviewed.

A sampling framework for rural and remote doctors.

A pilot survey by telephone interview, followed by a questionnaire of all rural doctors identified in Queensland, was used develop both a definition of rural practice that distinguishes it from urban general practice and a classification of rural and remote practice which assists in sampling of rural doctors. Questionnaire responses in specific geographic areas were compared using chi-square and Mantel-Haenszel chi-square tests. Several factors were found to differentiate rural from urban general practice consistently, thereby enabling a functional definition of rural practice to be developed.

Giant cell granuloma of the facial bones.

Giant cell granuloma of the facial bones is a benign, reparative metabolic lesion that usually presents as a painful, expansile mass of the mandible. However, 1 of our patients had the extremely rare findings of multiple other facial bone involvement. In this series of 3 patients followed for > 6 years, the combination of biopsy and clinical presentation provided a stereotypical pattern that enabled an accurate diagnosis in all cases.

Gastric dilatation and necrosis in bulimia: a case report.

Gastric dilatation and perforation is a rare complication in anorexia/bulimia sufferers. We describe a 24 year old female who presented with severe abdominal pain and vomiting, in whom radiographs demonstrated gross gastric dilatation and subsequent perforation. Although gastric perforation is rare, one can anticipate a rising incidence, with the apparent increase in the incidence of bulimia.

Embolisation in the management of peripancreatic pseudoaneurysm--a case report.

Peripancreatic pseudoaneurysms are an unusual cause of haemorrhage in patients with chronic pancreatitis and pseudocysts. We describe a 28 year old alcoholic male with documented chronic pancreatic pseudocysts, who presented with melaena and a large pulsatile epigastric mass. Ultrasound and digital subtraction angiography revealed a pseudoaneurysm of the gastroduodenal artery.

Hide and seek: pre-operative ultrasonic localization of non radio-opaque foreign bodies.

Ultrasound has long been used as a diagnostic and therapeutic tool in surgery. We have extended its use to hand surgery, where is has several applications. Non radio-opaque foreign body extraction is invariably a frustrating exercise of 'hide and seek'.

Binding of zinc and calcium to inositol phosphates (phytate) in vitro.

Inositol compounds with three to five phosphate groups (IP3-IP5) were produced by hydrolysis of phytate (inositol hexaphosphate, IP6) and their binding affinities for calcium and zinc investigated at neutral pH with relative concentrations that had been found in a range of students' meals. Zn solubility was negligible at many of these concentrations, with less Zn bound to precipitates of Ca-IP6 than Ca-IP5. The capacity to precipitate Zn at these ratios fell between IP5 and IP3.

Liver disease and bile duct abnormalities in adults with cystic fibrosis.

A quarter of adults with cystic fibrosis, 57 of 233, had abnormal liver function. Patients with hepatic dysfunction were further investigated by ultrasound, hepatobiliary scintigraphy, and endoscopic retrograde cholangiography (ERC). 17 of the 23 patients studied had abnormalities on imaging.

Vasculitis complicating cystic fibrosis.

Twelve patients with skin vasculitis complicating cystic fibrosis are described. Seven of these were proven histologically and of these two had systemic vascultitis. Staining of vasculitic tissue by the avidin-biotin immunoperoxidase technique using both monoclonal and polyclonal antisera directed against Haemophilus influenzae, staphylococcus aureus and Pseudomonas aeruginosa did not consistently reveal any bacterial antigens in these tissues.

Longitudinal CT study of parenchymal brain changes in glioma survivors.

We reviewed the serial CT studies obtained between 1974 and 1986 of 31 patients with malignant glioma who survived for 2 to 11 years after surgical removal of their tumors. In all cases surgery was followed by radiation therapy to the head (6000 rad) and chemotherapy. Patients were divided into two age groups: those under age 40 (n = 13) and those over age 40 (n = 18).

Visual system toxicity following intra-arterial chemotherapy.

We studied the effects of intra-arterial chemotherapy on the visual system of 29 consecutive patients with gliomas. As expected, infra-ophthalmic carotid infusion of cisplatin or carmustine (BCNU) was associated with clinically apparent anterior visual pathway lesions. Electroretinography revealed retinal dysfunction in patients without clinical abnormalities.

Dietary intakes of phytate and its meal distribution pattern amongst staff and students in an institution of higher education.

1. Seventy-six students and staff at Robert Gordon's Institute of Technology weighed all items of food consumed for 1 week. 2.